In the Western world, surgery for the repair of cleft palate dates to the early nineteenth century. Over time, early surgical techniques were supplanted by more innovative surgical solutions. The surgical management of velopharyngeal dysfunction emerged in parallel to the evolution of palatoplasty techniques, and to the more careful attention given to the speech outcomes of patients with repaired cleft palate. These operations required major advancements in anesthesia at a time when general anesthesia, endotracheal intubation, and even electricity were not yet available. This chapter recounts the history of cleft palate repair, anesthesia for such, and the surgical management of velopharyngeal dysfunction.